In 2024, there are still those who say that you cut the mayonnaise or that the cake does not rise if you are menstruating. There are still those who say “You’re a woman now” to her daughter after her first period. Blue liquid is still used instead of red in advertisements for menstrual products. Pads and tampons continue to be ordered quietly, as if they were contraband products. And perhaps as a result of all this, there are still many women writhing in pain without receiving any diagnosis after years of visits to specialists and many others who do not even go to the doctor because society has convinced them that “it is normal for periods to hurt.” ”.
But there are even more serious problems: science has also forgotten menstruation and there are still many unanswered questions: Why do some people have their first period at 8 years old and others at 15? Why do some women bleed a lot and others who barely fill a pad? And even, why do we menstruate if primates do not menstruate? Journalists María Zuil Navarro and Antonio Villarreal ask all these questions in the book ‘The Half That Bleeds’ (K.O. Books), while analyzing how and why both science and society have historically ignored menstruation.
It seems that nothing related to menstruation is clear. It’s all doubts. How is it possible that there are hardly any answers to so many questions?
Basically, there is a reason, and that is that menstruation is something that only affects women. Throughout history, it has been seen as a ‘minor’ issue because it affected the half of the population that was least interested. Science, medicine and religion have always been dominated by men and this has caused these topics to take a backseat. Men have focused their research and essays on the topics that seemed important to them, and menstruation has not been one of them. And it has been like this until almost today.
Is this changing? Has science already begun to look for some of these answers?
Until very few years ago, more women began to join science. Although this is changing, there is still a long way to go to achieve parity. Now we know more about menstruation: we know what its role is in the reproductive process and how it works in general terms, but there is still a lot of depth in the research to know why some bleed more and others less or why some suffer from premenstrual syndrome and others don’t, for example. Questions have been answered, but very slowly and still with many unknowns. The few investigations that are done are by these ‘lone wolves’ that we talk about in the book, who are very few and many are already retired. But there are more and more young women who are joining research and bringing this interest in menstruation.
The idea of ??writing the book arose after publishing in 2021 the article Media España is bleeding every month: neither doctors nor scientists yet know why. The relief of hundreds of women at seeing that someone was finally making their pain visible says a lot about how little is said about menstruation.
Menstruation has always been experienced from the intimate sphere. Many women have shared their problems around the cycle with other friends, with their mother, with their grandmother… With people very close to them. And the taboo surrounding menstruation has not yet been broken, or has only been partially broken, to talk about it out loud. The article made many feel understood because it talked about problems that they had, but that they had not heard from anyone else. Many women felt grateful that such a topic was finally featured in an article in a national media outlet. With the book, the response is being similar: women who feel heard, who have been able to answer certain questions they had and who have finally been able to read about this beyond the experience of people close to them.
What role does education have in how, socially, we have left aside menstruation?
They have not taught us what a normal cycle is like, how much it is normal to bleed, when a cycle is regular, when it is not… We ourselves cannot know if we are well or not. And that has a lot to do with education. Since school we have been told about the menstrual cycle for reproductive purposes and that’s it, but not as an indicator of health. They teach us this within the content of the reproductive cycle, but that is a mistake: menstruation is not just something reproductive. There are many women who are not going to be mothers and have menstruation all their lives. This approach is very reductionist because it means that menstruation is only of interest at the time of ovulation, and that is not true. The menstrual cycle is something that regulates us throughout the month.
Following this article, you wrote the book. It is called ‘The Bleeding Half’ because menstruation is not something that affects just a few people, but half of the world’s population.
With both the title of the book and the headline of the article, we wanted to play with the prejudice that the reader has towards menstruation. We didn’t want to name it in the headline to force them to read it. And it worked super well precisely for that reason: if we put ‘menstruation’ it would surely have been a disincentive. We wanted to give it the importance that it is something that affects half of the population and that for that reason alone it should interest you without the word ‘menstruation’ putting you off, which is what happens especially to men.
Despite this, it is little studied. You say that rarely in science is there such an obvious imbalance between the number of people who suffer from something and how little it is studied.
Precisely because of androcentrism in science, which explains how in the design of science, technology and many other things the pattern of man has always been used as the default pattern for everything. Furthermore, lack of knowledge about menstruation has meant that for much of history it was viewed with certain suspicion, because it was not understood. It was not known why there was periodic bleeding and the disappearance of menstruation was associated with the appearance of children. In the end, the reaction was one of fear and superstition rather than a search for answers to all these questions.
In the book, you give a piece of information: “If you search for ‘dysmenorrhea’ (menstrual pain) in PubMed, the largest scientific research compilation portal in the world, the page returns more than 8,434 results, a third of the 27,675 studies that appear if search on ‘erectile dysfunction’.”
The justification of science for this difference between research is that menstrual pain is not a matter of life or death, which is true. But that argument falls apart when you see the number of studies dedicated to erectile dysfunction or baldness, that no one dies from it either and much more research is done. That argument was not valid for us and we believe that it has more to do with this androcentrism. This leaves out women and people with menstruation, because it is not taken into account when designing these trials many times, as happened with the Covid vaccine.
Menstrual pain is not life or death, but it does hurt, unlike baldness and erectile dysfunction.
Of course, medicine is not only for life or death cases, but also to improve people’s lives, and menstrual pain affects the daily lives of many millions of people. In addition, it also affects social and economic levels. The issue of menstrual loss demonstrates this: people who, for example, suffer from endometriosis are not going to be as productive as people who do not have it, and the fact that it takes us eight years on average to diagnose it has a great economic impact. Even looking at it this way, it pays to improve the diagnosis of menstrual pain, because you will have more productive people who go to the emergency room less.
In the book you say that menstruation can warn us in advance of some diseases. We are missing invaluable information for the health of women and people who menstruate.
Yes, and we keep missing it, which is the sad thing. Enriqueta Barranco (specialist in gynecology and obstetrics) was the first person who thought of analyzing menstrual blood. It is surprising, because it is a material that is very within reach. Analyzing it, she saw that there were many endocrine disruptors. It allows us to know the amount of pollution we have in our body. But not only that; Any menstrual alteration has to do with the functioning of our body. The endocrinologist Carme Valls also said that a woman who has a heart attack will have had a menstrual disorder before. We are losing super valuable information and potential quality of life.
The period has not only been ignored by science, but also socially: we have normalized pain. All women have heard at some point that “it is normal for periods to hurt.”
Since it is a women’s issue, it is not given importance. When you go to the doctor, in the vast majority of cases, you find a doctor who tells you “Well, it’s normal” and prescribes you an enantyum or an ibuprofen. We trust the doctors and integrate this message, but, in reality, there is nothing normal about having a period that hurts. And if on top of that it has hurt my mother all her life and she has lived with it, we endure, because she is ‘normal’. Many endure the pain without going to the doctor and the saddest thing is that many of those who do go return home without answers. It seems like it is the divine punishment that we have had to experience for being women: that is how religion and society have made us feel for centuries.
Diagnosing period pain can be a long process. Endometriosis affects one in nine women, but it takes an average of eight to ten years to diagnose. Because?
I thought it would be something really difficult to diagnose, but Carme Valls told us that actually diagnosing the reason for the vast majority of menstrual pain only takes two or three consultations; You have to do three specific tests. Those years have to do with the fact that there is no protocol nor are there standardized guidelines to know what to do when a person with menstrual pain goes to a consultation. It takes so many years because when a person goes to the doctor to find an answer to their pain, what can happen is that they spend a lot of time in a gymkhana of specialists, tests and appointments, that they stop going because they lose hope, that later go back to square one… The gymkhana is different for each person, and depends on the autonomous community in which you live, luck, the speed of referrals to specialists…
It seems that all problems related to periods have a single solution: the pill.
The pill is beneficial in many cases. The problem is that it was seen that it camouflaged or covered up many menstrual problems and it began to be prescribed for anything. It has even been prescribed for acne problems and other things that had nothing to do with it. Maybe you were prescribed it when you were 16 and you could spend ten years taking it without anyone contacting you again to follow up. Nor did anyone inform you that if you smoke you have a higher risk of thrombosis. There are many side effects that have been discovered along the way after being marketed for years. New generations no longer see the pill as the only way to have family planning, but there are also many women who continue taking the pill out of inertia.
The expression par excellence when you get your period for the first time (menarche) is “You are now a woman.” Why should we stop saying this?
Because it is a totally unnecessary burden that is placed on women who at that moment are children or adolescents. There are women who have told us that their toys were even taken away when they got their period. That is psychologically terrible, especially considering that menarche is getting earlier and earlier. Furthermore, thinking that because you have menstruation you are a woman is wrong. Just as wrong as thinking that when your period stops with menopause you stop being a woman. There are also trans men who have periods and you can be a woman who does not have menstruation and still be a woman. It is a very reductionist expression. Each one experiences this menarche in a different way. There are millions of different experiences, but in the survey we did for the book, “You are a woman now” came up dozens of times as an unpleasant memory. A little like: “What do you mean by that? What does it mean that she is already a woman? Some women told us that from that moment on they were prohibited from playing with children.
You make a very important point at the beginning of the book: not only women menstruate. There are trans men and non-binary people who also menstruate.
It is important to make this section because it is another of the taboos that surround menstruation. In fact, I will tell you that the vast majority of times when we talk about ‘people who menstruate’ and people come out to complain, it always surprises me because they say: “Trans women don’t menstruate.” To that point it is the lack of knowledge that these people do not stop to think that we are talking about trans men, not trans women. Obviously, in the book we talk a lot about women because on a cultural level they are the ones it has affected the most, but we did not want to leave this reality aside.
Is menstruation still taboo?
I think less and less. It also depends a lot on the place. If we talk from the point of view of Spain and the current generation, perhaps menstruation is no longer taboo. It’s already something we can talk about calmly. I see more and more women talking about menstruation out loud with people in their work environment, on the internet… We have made a lot of progress there. There is still a lot of taboo, for example, when we talk about menstruation and sex, but we have already surpassed a certain level. But if we talk about other countries and cultures, the taboo is still brutal. There are still women in Nepal who die by the Chhaupadi method, which locks them in a menstrual hut away from the rest. As long as this continues to happen, it cannot be said that menstruation is no longer a taboo, because there are still millions of women who see their lives conditioned by enemas, prohibitions and superstitions that make up the menstrual taboo.
Menopause is another open front for the world of research… And another social taboo yet to be broken. Double challenge.
Completely. In recent years, just as is happening with menstruation, speeches and books that talk about menopause are finally beginning to emerge, but there is still a lot to do. If menstruation has been seen as something to be ashamed of, menopause, which is something that happens not only to women, but also to older women, which is already a stigma, makes it become in a double stigma. Many reach that age without knowing very well what is going to happen, without knowing the symptoms, medicated again to alleviate the symptoms with medications that generate more side effects than the menopause itself and with a lot of ignorance on the part of medicine as well. This sector has the problems that menstruation already has but multiplied by two.
As science advances, what do we do? Any practical advice to have a better relationship with our menstruation?
We have to talk about menstruation. Let’s get rid of the stigma and fear of talking about it out loud. It’s something that I do and I think it helps to normalize it and get other people interested, learn, and dare to cast their doubts and talk about it naturally. I also believe that the Internet is being a very powerful tool to access a lot of popularizers who talk about menstruation and who can help us get to know ourselves better, suggest eating habits that help us with the cycle and open our minds a lot. Information is power and now it is easier than ever to inform yourself about what is known about menstruation.